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This eBook has been developed by Idorsia Pharmaceuticals Ltd as a resource to help the understanding of hypertension. It provides a useful summary of current information about the condition, the diagnosis procedure and available treatments. It also outlines the strategies people with hypertension can use to manage their condition as effectively as possible.
The book is intended for the use of a general audience.
About this eBook
“I struggled to accept the diagnosis at first, because in my mind, only ‘old’ people had high blood pressure and I was just 48 years young! Now I know that whatever your age, it’s important to look after your body.”
— Patient
Introduction
High blood pressure (also known as hypertension) is one of the most common medical conditions and its prevalence continues to rise. According to a recent study, the number of people affected by high blood pressure has almost doubled over the past 40 years, with about 1.13 billion people living with the condition worldwide.
It is important to understand how our body controls our blood pressure, risk factors for hypertension and the different types of hypertension.
Types of hypertension?
What are the
risk factors for hypertension?
How is blood
pressure controlled
by the body?
Understanding hypertension
Diagnosis and treatment of hypertension
Resistant hypertension
Practical guidance on managing
hypertension
Introduction
Disclaimer
This resource has been developed by Idorsia Pharmaceuticals in order to provide an environment to deliver a better understanding of resistant hypertension and to pool information regarding the disease, the diagnosis procedure, available treatments and the impact it could have on the life of someone diagnosed with resistant hypertension. The resource is for use by a general audience.
The information in this resource is not intended as a substitute for advice/treatment by a physician, whose instructions should always be followed. Neither does the information provided constitute an alternative to advice from a doctor or a pharmacist and should not be used on its own to produce a diagnosis or to commence or cease a particular treatment.
The links provided are for informational purposes only; they do not constitute an endorsement or an approval from Idorsia Pharmaceuticals Ltd of the services or opinions of the corporation, organization or individual.
Disclaimer
Idorsia Pharmaceuticals Ltd bears no responsibility for the accuracy, legality or content of the external sites or subsequent links. You are requested to contact the respective external site for answers to questions regarding its content.
The information provided is valid on the publication date but may be subject to further modifications. Even though Idorsia aims to provide accurate and up to date information at all times, please acknowledge that the present resource is made available “as is”. Idorsia does not give any warranty or representation, whether expressly stated or implied, of any kind related to the comprehensiveness, usefulness, reliability or timelines of the content of this resource. Idorsia cannot be held liable for any direct or indirect damage of a material or non-material nature that might be caused by the use or non-use of the information presented.
Introduction
Understanding BED
Diagnosis and treatment of BED
The burden of BED
Practical Guidance on Managing BED
About this eBook
About this eBook
This eBook has been developed by Idorsia Pharmaceuticals Ltd as a resource to help the understanding of hypertension. It provides a useful summary of current information about the condition, the diagnosis procedure and available treatments. It also outlines the strategies people with hypertension can use to manage their condition as effectively as possible.
The book is intended for the use of a general audience.
As hypertension generally develops over many years with no distinctive warning signs or symptoms, many people don’t even realize they have high blood pressure. Left untreated, it can lead to life-threatening conditions such as heart failure, stroke or kidney disease. The World Health Organization estimates that hypertension causes 7.5 million deaths a year, which equates to about 12.8% of all deaths worldwide.
Many of these deaths could be prevented, as high blood
pressure can be detected with a simple test and can often
be controlled with a healthier lifestyle and appropriate medication.
Complications
of untreated
hypertension
Complications of untreated hypertension
“It came as an absolute shock to me to
be told that my blood pressure was dangerously high. I had not had any symptoms and was just getting on with
my life.”
— Patient
How is blood pressure controlled by the body?
Blood delivers nutrients and oxygen to all parts of the body, pushed through a vast network of large and small blood vessels when the heart contracts.
By widening or narrowing, the vessels adjust to the blood pressure and keep the blood flowing at a healthy rate.
The more blood the heart pumps and the narrower the vessels, the higher the blood pressure.
There are several factors that contribute to systolic blood pressure – the measure of the pressure inside your blood vessels when the heart contracts.
One of them is the changing structure of the walls of our blood vessels as we grow older. They thicken and become stiffer and less flexible. This increases resistance to blood flow; the heart has to pump harder to force the blood through, leading to increasing blood pressure.
Blood pressure is not a steady number, but can be affected by what time of day it is, eating and exercise habits, stress levels and other factors. These short-time fluctuations are normally nothing to worry about, but if blood pressure remains too high for a long period of time, problems may arise. Hypertension – high blood pressure – can “overwork” the heart and cause damage to blood vessels, which can harm other important organs over time.
Understanding hypertension
Introduction
Understanding hypertension
Diagnosis and treatment of hypertension
Resistant hypertension
Practical guidance on managing
hypertension
What are the risk factors for hypertension?
Family history of high blood pressure
Etiology (black people have a higher risk
of developing hypertension)
Overweight and obesity
Insufficient physical exercise
High salt and alcohol consumption
Diabetes, gout or kidney disease
Pregnancy
Age (the older you get, the greater your
chance of developing hypertension).
Types of hypertension?
Hypertension can be classified as either ‘essential’ (also known as primary or idiopathic hypertension), or ‘secondary’ hypertension.
Essential hypertension (which forms about 90-95% of all cases) is typically defined as hypertension with no known cause.
Secondary hypertension, on the other hand, is caused by an underlying medical condition. An example of this is chronic kidney disease, which narrows the arteries in the kidney.
When high blood pressure can’t be lowered by combination of at least three standard treatments,
it can be described as ‘resistant hypertension’, which
is the focus of another section of this eBook.
Diagnosis and treatment
of hypertension
Almost everyone is familiar with the very simple procedure of having their blood pressure measured, yet relatively few understand the meaning of the two numbers recorded at the reading.
“When I was first diagnosed I bought a blood-pressure pump so I could take my own readings at home and stay on top of my health. This was really helpful as I could tell when my medications weren’t working anymore and simply make an appointment with my doctor to review my treatment.”
— Patient
Introduction
Understanding hypertension
Diagnosis and treatment of hypertension
Resistant hypertension
Practical guidance on managing
hypertension
Lowering and controlling blood-pressure levels begins by understanding these numbers.
“When my doctor first told me I had high blood pressure, I thought he
had it wrong, so I ignored the recommendations. Five years later
I had to undergo bypass surgery as
a result of unstable angina. After the surgery, I took my medications every day, making sure I followed the doctor’s orders to the letter. Today,
I can live a normal life that’s not affected by my blood pressure.”
— Patient
Can blood pressure be
too low?
What do the numbers mean on a blood pressure reading?
Systolic and diastolic pressure
What are the different stages of hypertension?
What are the different stages of hypertension?
When a person has elevated blood pressure, their blood pressure is higher than normal, but is not in the hypertension range yet. Medical treatment and, importantly, lifestyle changes can prevent blood pressure from rising further, and it is important to have frequent blood pressure checks to monitor development.
In stage 1 hypertension, systolic pressure ranges from 130 to 139 mm Hg, or diastolic pressure ranges from 80 to 89 mm Hg.
For the more severe stage 2 hypertension, systolic pressure is 140 mm Hg or higher, or diastolic pressure is 90 mm Hg or higher.
A systolic pressure of 180 mm Hg or higher, or a diastolic pressure of 120 mm Hg or higher, is referred to as a hypertensive crisis. It can be caused by a range of factors, such as having a stroke, heart attack, kidney failure or interaction between medications. This dangerous spike in blood pressure can damage blood vessels and organs and requires immediate medical attention.
Symptoms of a hypertensive crisis may include severe chest pain and headache, blurred vision, nausea, anxiety and shortness of breath. The affected person might also be unresponsive or have seizures.
Can blood pressure be too low?
Blood pressure consistently lower than 90/60 mm Hg is known as hypotension.
Some people have naturally low blood pressure, which doesn’t cause any symptoms and usually doesn’t require treatment.
However, if blood pressure is too low, the person might feel dizzy and lightheaded.
Any sudden drops in blood pressure require immediate medical attention – they can be life-threatening. Causes include severe blood loss, dehydration and severe allergic reactions.
Systolic anddiastolic pressure
What do the numbers mean
on a blood pressure reading?
Take the example of 130/80 (130 over 80), which is the upper threshold for normal blood pressure, according
to the new guidelines issued by the American Heart Association in 2017.
The top number – 130 millimeters of mercury (mm Hg), the unit used to measure blood pressure – is the systolic blood pressure. It indicates the amount of pressure the blood is exerting against the artery walls during heartbeats.
The bottom number – 80 mm Hg – stands for the diastolic blood pressure, which indicates how much pressure the blood is exerting against the artery walls between beats, when the heart is resting.
In this context, it is worth mentioning that blood pressure and heart rate (the number of times the heart beats per minute) are two separate measurements and indicators of health. They do not necessarily increase at the same rate.
While making changes towards a healthier lifestyle (as described in the next section) often has a significant impact on lowering blood pressure, they might not be enough on their own and need to be supported by medical treatment. The category of drugs prescribed will depend on the blood pressure category and medical history of the patient.
What medical treatments are available for hypertension?
Blood pressure medications are often more effective in combination than as a single drug. However, finding the most effective combination of drugs while keeping side effects to a minimum can be a challenge. Avoiding unwanted interactions between different medications is therefore an important consideration for the prescribing healthcare professional.
Types of medication for highblood pressure
ACE (angiotensin-converting enzyme) inhibitors block the formation of angiotensin II, a substance that narrows blood vessels, which, in turn, lowers blood pressure. People with chronic kidney disease may benefit from having an ACE
inhibitor as one of their medications.
Beta blockers work by blocking the effects of epinephrine, a hormone also known as adrenaline. This leads to the heart beating more slowly and with less force and to improved blood flow, which reduces blood pressure.
Alpha blockers keep the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls
of smaller blood vessels, which improves blood flow and lowers blood pressure.
Diuretics target the kidneys to help the body to eliminate sodium and water, which reduces blood volume.
ARBs (angiotensin II receptor blockers) block the action – rather than the formation – of angiotensin II. Both ACEs and ARBs are often part of the treatment for people with chronic kidney disease.
Calcium-channel blockers reduce electrical conduction within the heart by blocking the entry of calcium into the muscle cells. This decreases the force of contraction of the muscle cells and dilates arteries, thus reducing blood pressure.
"I was given three different tablets and it has been a real battle to get my blood pressure down. My blood pressure is never quite what it should be and I find it quite frightening that they can’t seem to control it. Last year
I had a small stroke, fortunately I recovered very well and it is only my speech that is sometimes slurred if I get tired."
— Patient
Resistant hypertension
If someone’s high blood pressure can’t be lowered despite treatment with a combination of three anti-hypertensive drugs of different categories (including a diuretic), they may have resistant hypertension.
Introduction
Understanding hypertension
Diagnosis and treatment of hypertension
Resistant hypertension
Practical guidance on managing
hypertension
How is resistant hypertension diagnosed?
How is resistant hypertension diagnosed?
The diagnosis of true resistant hypertension can be challenging, as the so-called white-coat effect must be ruled out first.
For many people, their blood pressure is higher when it is taken in a medical setting (by a doctor or nurse in their traditional ‘white coats’), compared to when it is taken at home.
By having patients wear an automatic blood pressure recorder for 24 hours and/or check their blood pressure several times a day, a better account of fluctuations can be recorded and the white-coat effect reduced.
For a correct diagnosis of resistant hypertension,
a number of conditions that can cause apparent resistance need to be eliminated. Factors like inappropriate medication dosage and noncompliant patient behavior need to be taken into consideration as well.
Estimations of how many patients with high blood pressure have true resistant hypertension range from 2% all the way to 10%, which reflects the difficulty in diagnosis.
Compared to “regular” hypertension, patients with resistant hypertension are more likely to be older (above 75 years of age), overweight and to have a medical history of diabetes, kidney and heart disease, stroke, and/or sleep apnea. Chronic kidney disease and diabetes in particular make these patients more vulnerable and increase the complexity of finding the right treatment combination.
How common is resistant hypertension and who gets it ?
Generally, the approach for resistant hypertension is to add a fourth antihypertensive medication to the three drugs the patient is already taking. The fourth drug often has a different mechanism of action (the way it works in the body) compared to the other three medications. Yet these drugs often have their own limitations and can be associated with side effects that force the patient to stop taking them.
Therefore, new treatment options for resistant hypertension are needed, especially for patients in whom other, traditional forms of antihypertensive drugs are ineffective.
How is resistant
hypertension treated?
“I find it reassuring to go for regular check-ups with my doctor. That way they can easily pick up on any adjustments needed for my medications and I can have peace of mind that everything’s under control.”
— Patient
“Because of the medication I’m on for my blood pressure, I need to be careful not to push myself too hard when I exercise. Instead, I listen to the signs of my body and take breaks when I need; knowing that anything I can do to stay fit is going to help me manage my condition.”
“Positive lifestyle choices have kept me in control of my blood pressure; I make sure to keep a healthier diet than I did when I was younger and try to do some sort of exercise every day.”
— Patient
Practical guidance on managing
hypertension
While effective medical treatment can be the key to lowering blood pressure, especially in severe and resistant hypertension, the role of a healthy lifestyle cannot be overstated.
Introduction
Understanding hypertension
Diagnosis and treatment of hypertension
Resistant hypertension
Practical guidance on managing
hypertension
Eating healthily
High blood pressure and sex
Exercise several times a week
Watch your weight
Regular physical activity — at least 30 minutes several times a week — can bring blood pressure down to safer levels, or help to avoid developing hypertension altogether if the numbers are only slightly high (elevated hypertension).
Types of exercise that are well-suited to lowering blood pressure include walking and hiking, jogging, cycling, swimming and dancing. Weight training can also be beneficial.
Anyone with a long-term medical condition should speak to their doctor before starting a new exercise program, to check if they should be aware of any additional considerations.
Whatever the individual exercise routine looks like, it is important to be consistent and stick to it in order to keep blood pressure down.
Exercise several times a week
The lifestyle changes described in this section can not only help to lower blood pressure and keep it down, but also to avoid, delay or reduce the need for medical treatment.
If you find you need support beyond your own social circle,
you might consider joining a hypertension support group that provides both emotional guidance and practical tips on coping with the condition.
— Patient
Watch your weight
As weight increases, blood pressure often increases as well. Reaching and maintaining a healthy weight is therefore one of the most effective measures for reducing blood pressure and keeping it in check.
Although sexual activity is unlikely to pose an actual health risk for people with hypertension, high blood pressure can affect the quality of their sex life.
Over time, high blood pressure damages the lining of blood vessels and causes them to stiffen and narrow, which limits blood flow.
For some men, this decreased blood flow makes it difficult to achieve and maintain erections, medically known as erectile dysfunction. The drugs used to treat hypertension can have similar effects, depending on their mechanism of action.
High blood pressure can also reduce sexual desire and increase anxiety and fatigue in both men and women, which can take a toll on relationships and emotional wellbeing.
High blood pressure and sex
By discussing any concerns with a doctor and seeking additional professional help if necessary, people with high blood pressure can address many of these problems. This might include switching to medications that may have fewer side effects.
The so-called DASH (Dietary Approaches to Stop Hypertension) eating plan is supported by the US National Institutes of Health and has been shown to be beneficial for people with and without hypertension. The eating plan is rich in whole grains, fruits, vegetables and low-fat dairy products, and is low in saturated fat, cholesterol, salt and added sugar. It includes the following elements:
Changing established eating habits is not easy,
but some simple tricks can help:
Eating healthily
-
-
-
-
-
-
-
-
fruits and vegetables
whole grains
low-fat dairy products
unsalted beans and lentils
fish
skinless poultry
herbs and spices
small quantities of unsalted nuts and seeds, vegetable oils and lean red meat
-
-
-
Keep a food diary. Writing down what you eat, even for just a week, can shed surprising light on your true eating habits. Monitor what you eat, how much, when and why.
Be smart and educate yourself before you shop or go to a restaurant.
Be creative in your kitchen – use herbs or spices to add flavor to your food, or try a new (DASH-friendly) recipe.
Go easy on the salt
Limit alcohol intake
Don’t smoke
De-stress your life
Reducing salt (sodium) intake can make a positive difference on blood pressure. The DASH eating plan recommends a maximum of 2300 milligrams of sodium a day. In addition to reducing the intake of “regular” table salt, it is important to check the labels – and sodium levels – of prepared and processed foods.
Sodium occurs in a number of substances added to processed foods, such as glutamate and baking soda. Generally, unprocessed and whole foods are better choices for people on a low-salt diet. Fruits and vegetables in particular are important components of the DASH eating plan – they are low in sodium but high in potassium and can therefore improve the potassium-to-sodium ratio, which helps to lower blood pressure.
Go easy
on the salt
The beneficial effect of small amounts of alcohol is debatable when it comes to lowering blood pressure – and drinking more than that might not only raise blood pressure, but also make blood pressure medications less effective.
It is therefore recommended to keep to a limit of no more than one drink a day for women, or two drinks a day for men. One drink equals roughly 14 grams of pure alcohol – which is contained in a regular beer or small glass of wine, for example.
Limit alcohol
intake
Don’t smoke
Take a break from the stressor. It is not easy to give yourself permission to step away from that big work task (or from that annoying person at the Christmas party, for that matter). But allowing yourself to take a breather can provide a fresh perspective and make you feel less overwhelmed.
De-stress your life
The nicotine in cigarettes raises blood pressure and heart rate immediately during smoking. In the longer term, tobacco can damage the lining of blood vessels, causing them to narrow and harden, which increases blood pressure and puts additional strain on the heart.
Stress is an important contributor to high blood pressure. While it is almost impossible to eliminate all of life’s stressors (be they related to work, family, money or health), there are a range of techniques to help manage them effectively:
Exercise. A quick walk or run can have an immediate positive effect that can last for several hours, even and especially on a stressful day.
Smile and laugh. Humor or just a friendly face can help to relieve tension and lower stress levels.
Be mindful. Meditation, yoga and other relaxation techniques have been shown to help some people to relax and focus, physically and mentally. Mindfulness can help to develop new perspectives and release emotions that may have contributed to the feeling of stress.
Talk about your feelings. Call a friend, meet for a walk with the neighbor or have lunch with a family member. Sharing your worries with a person you trust often alleviates stress. However, it’s important that the person you talk to is not one of your stressors.
Introduction
High blood pressure (also known as hypertension) is one of the most common medical conditions and its prevalence continues to rise. According to a recent study, the number of people affected by high blood pressure has almost doubled over the past 40 years, with about 1.13 billion people living with the condition worldwide.
“I struggled to accept the diagnosis
at first, because in my mind, only ‘old’ people had high blood pressure and
I was just 48 years young! Now I know that whatever your age, it’s important to look after your body.”
— Patient
Introduction
As hypertension generally develops over many years with no distinctive warning signs or symptoms, many people don’t even realize they have high blood pressure. Left untreated, it can lead to life-threatening conditions such as heart failure, stroke or kidney disease. The World Health Organization estimates that hypertension causes 7.5 million deaths a year, which equates to about 12.8% of all deaths worldwide.
Many of these deaths could be prevented, as high blood pressure can be detected with a simple test and can often be controlled with a healthier lifestyle and appropriate medication.
Complications
of untreated hypertension
Complications of untreated hypertension
CLOSE
“It came as an absolute shock to me
to be told that my blood pressure was dangerously high. I had not had any symptoms and was just getting on with my life.”
— Patient
Understanding hypertension
Understanding hypertension
Blood pressure is not a steady number, but can
be affected by what time of day it is, eating and exercise habits, stress levels and other factors. These short-time fluctuations are normally nothing to worry about, but if blood pressure remains too high for a long period of time, problems may arise. Hypertension – high blood pressure – can “overwork” the heart and cause damage to blood vessels, which can harm other important organs over time.
Types of hypertension?
What are the
risk factors for hypertension?
How is blood pressure controlled by the body?
It is important to understand how our body controls our blood pressure, risk factors for hypertension and the different types of hypertension.
How is blood pressure controlled by the body?
Blood delivers nutrients and oxygen to all parts of the body, pushed through a vast network of large and small blood vessels when the heart contracts.
CLOSE
By widening or narrowing, the vessels adjust to the blood pressure and keep the blood flowing at a healthy rate.
The more blood the heart pumps and the narrower the vessels, the higher the blood pressure.
There are several factors that contribute to systolic blood pressure – the measure of the pressure inside your blood vessels when the heart contracts.
One of them is the changing structure of the walls of our blood vessels as we grow older. They thicken and become stiffer and less flexible. This increases resistance to blood flow; the heart has to pump harder to force the blood through, leading to increasing blood pressure.
Possible long-term complications of untreated hypertension
Systolic pressure
is measured when the heart contracts
Diastolic pressure
is measured when the heart relaxes, between beats
What are the risk factors for hypertension?
Family history of high blood pressure
Etiology (black people have a higher risk
of developing hypertension)
Overweight and obesity
Insufficient physical exercise
High salt and alcohol consumption
CLOSE
Diabetes, gout or kidney disease
Pregnancy
Age (the older you get, the greater your chance of developing hypertension).
Types of hypertension?
Hypertension can be classified as either ‘essential’ (also known as primary or idiopathic hypertension), or ‘secondary’ hypertension.
Essential hypertension (which forms about 90-95% of all cases) is typically defined as hypertension with no known cause.
Secondary hypertension, on the other hand, is caused by an underlying medical condition. An example of this is chronic kidney disease, which narrows the arteries in the kidney.
When high blood pressure can’t be lowered by combination of at least three standard treatments, it can be described as ‘resistant hypertension’, which is the focus of another section of this eBook.
CLOSE
“When I was first diagnosed I bought a blood-pressure pump so I could take my own readings at home and stay
on top of my health. This was really helpful as I could tell when my medications weren’t working anymore and simply make an appointment with my doctor to review my treatment.”
— Patient
Diagnosis and treatment of hypertension
Almost everyone is familiar with the very simpleprocedure of having their blood pressuremeasured, yet relatively few understand themeaning of the two numbers recorded
at thereading.
What tests are used to diagnose insomnia?
Diagnosis and treatment of hypertension
Lowering and controlling blood pressure levelsbegins by understanding these numbers.
“When my doctor first told me Ihad high blood pressure, I thoughthe had it wrong, so I ignored therecommendations. Five years laterI had to undergo bypass surgery asa result of unstable angina. Afterthe surgery, I took my medicationsevery day, making sure I followedthe doctor’s orders to the letter.Today, I can live a normal life that’snot affected by my blood pressure.”
- Patient
What do the numbers mean ona blood pressure reading?
What are the different stages of hypertension?
Systolic and diastolic pressure
Can blood pressure be too low?
Systolic and diastolic
pressure
CLOSE
What are the different stages of hypertension?
When a person has elevated blood pressure, their blood pressure is higher than normal, but is not in the hypertension range yet. Medical treatment and, importantly, lifestyle changes can prevent blood pressure from rising further, and it is important to have frequent blood pressure checks to monitor development.
CLOSE
In stage 1 hypertension, systolic pressure ranges from 130 to 139 mm Hg, or diastolic pressure ranges from 80 to 89 mm Hg.
For the more severe stage 2 hypertension, systolic pressure is 140 mm Hg or higher,
or diastolic pressure is 90 mm Hg or higher.
A systolic pressure of 180 mm Hg or higher, or a diastolic pressure of 120 mm Hg or higher, is referred to as a hypertensive crisis. It can be caused by a range of factors, such as having a stroke, heart attack, kidney failure or interaction between medications. This dangerous spike in blood pressure can damage blood vessels and organs and requires immediate medical attention.
Symptoms of a hypertensive crisis may include severe chest pain and headache, blurred vision, nausea, anxiety and shortness of breath. The affected person might also be unresponsive or have seizures.
What do the numbers mean ona blood pressure reading?
Take the example of 130/80 (130 over 80), which is the upper threshold for normal blood pressure, according to the new guidelines issued by the American Heart Association in 2017.
CLOSE
The top number – 130 millimeters of mercury (mm Hg), the unit used to measure blood pressure – is the systolic blood pressure. It indicates the amount of pressure the blood is exerting against the artery walls during heartbeats.
The bottom number – 80 mm Hg – stands for the diastolic blood pressure, which indicates how much pressure the blood is exerting against the artery walls between beats, when the heart is resting.
In this context, it is worth mentioning that blood pressure and heart rate (the number of times the heart beats per minute) are two separate measurements and indicators of health. They do not necessarily increase at the same rate.
Can blood pressure
be too low?
Blood pressure consistently lower than 90/60 mm Hg is known as hypotension.
CLOSE
Some people have naturally low blood pressure, which doesn’t cause any symptoms and usually doesn’t require treatment.
However, if blood pressure is too low, the person might feel dizzy and lightheaded.
Any sudden drops in blood pressure require immediate medical attention – they can be life-threatening. Causes include severe blood loss, dehydration and severe allergic reactions.
What medical treatments are available for hypertension?
While making changes towards a healthier lifestyle (as described in the next section) often has a significant impact on lowering blood pressure, they might not be enough on their own and need to be supported by medical treatment. The category of drugs prescribed will depend on the blood pressure category and medical history of the patient.
Blood pressure medications are often more effective in combination than as a single drug. However, finding the most effective combination
of drugs while keeping side effects to a minimum can be a challenge. Avoiding unwanted interactions between different medications is therefore an important consideration for the prescribing healthcare professional.
Diuretics target the kidneys to help the body to eliminate sodium and water, which reduces blood volume.
Types of medication for highblood pressure
Alpha blockers keep the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller blood vessels, which improves blood flow and lowers blood pressure.
Beta blockers work by blocking the effects of epinephrine, a hormone also known as adrenaline. This leads to the heart beating more slowly and with less force and to improved blood flow, which reduces blood pressure.
ACE (angiotensin-converting enzyme) inhibitors block the formation of angiotensin II, a substance that narrows blood vessels, which, in turn, lowers blood pressure. People with chronic kidney disease may benefit from having an ACE inhibitor as one of their medications.
ARBs (angiotensin II receptor blockers) block the action – rather than the formation – of angiotensin II. Both ACEs and ARBs are often part of the treatment for people with chronic kidney disease.
Calcium-channel blockers reduce electrical conduction within the heart by blocking the entry of calcium into the muscle cells. This decreases the force of contraction of the muscle cells and dilates arteries, thus reducing blood pressure.
“I was given three different tablets and it has been a real battle to get
my blood pressure down. My blood pressure is never quite what it should be and I find it quite frightening that they can’t seem to control it. Last year I had a small stroke, fortunately I recovered very well and it is only my speech that is sometimes slurred if
I get tired.”
— Patient
Resistant hypertension
The impact of insomnia is often underestimated.
In reality, it can be a distressing condition that can reduce quality of life. It may affect many aspects
of daily life, from studying and employment to social activities and relationships.
Insomnia can have a significant economic impact and increases the risk of accident and injury on the road or in the workplace.
Resistant hypertension
How is resistant hypertension
diagnosed?
How is resistant hypertension diagnosed?
The diagnosis of true resistant hypertension can be challenging, as the so-called white-coat effect must be ruled out first.
CLOSE
For many people, their blood pressure
is higher when it is taken in a medical setting (by a doctor or nurse in their traditional ‘white coats’), compared to when it is taken at home.
By having patients wear an automatic blood pressure recorder for 24 hours and/or check their blood pressure several times a day, a better account of fluctuations can be recorded and the white-coat effect reduced.
For a correct diagnosis of resistant hypertension, a number of conditions that can cause apparent resistance need to be eliminated. Factors like inappropriate medication dosage and noncompliant patient behavior need to be taken into consideration as well.
How common is resistant hypertension and who gets it ?
If someone’s high blood pressure can’t be lowered despite treatment with a combination of three anti-hypertensive drugs of different categories (including a diuretic), they may have resistant hypertension.
Estimations of how many patients with high blood pressure have true resistant hypertension range from 2% all the way to 10%, which reflects the difficulty in diagnosis.
How is resistant
hypertension treated?
Estimations of how many patients with high blood pressure have true resistant hypertension range from 2% all the way to 10%, which reflects the difficulty in diagnosis.
- Patient
Compared to “regular” hypertension, patients with resistant hypertension are more likely to be older (above 75 years of age), overweight and to have a medical history of diabetes, kidney and heart disease, stroke, and/or sleep apnea. Chronic kidney disease and diabetes in particular make these patients more vulnerable and increase the complexity of finding the right treatment combination.
Generally, the approach for resistant hypertension is to add a fourth antihypertensive medication to the three drugs the patient is already taking. The fourth drug often has a different mechanism of action (the way it works in the body) compared to the other three medications. Yet these drugs often have their own limitations and can be associated with side effects that force the patient to stop taking them.
Eating healthily
High blood pressure and sex
Exercise several times a week
Watch your weight
Practical guidance on managing hypertension
While effective medical treatment can be the key
to lowering blood pressure, especially in severe
and resistant hypertension, the role of a healthy lifestyle cannot be overstated.
“Some mornings you get up and wonder how on earth you are going to get through the day. Somehow you do, but it can be a massive struggle.”
— Patient
Practical guidance on
managing hypertension
The lifestyle changes described in this section can not only help to lower blood pressure and keep it down, but also to avoid, delay or reduce the need for medical treatment.
If you find you need support beyond your own social circle, you might consider joining a hypertension support group that provides both emotional guidance and practical tips on coping with the condition.
“Because of the medication I’m on for my blood pressure, I need to be careful not to push myself too hard when I exercise. Instead, I listen to the signs of my body and take breaks when I need; knowing that anything I can do
to stay fit is going to help me manage my condition.”
- Patient
Watch your weight
As weight increases, blood pressure often increases as well. Reaching and maintaining a healthy weight is therefore one of the most effective measures for reducing blood pressure and keeping it in check.
CLOSE
Exercise several times
a week
Regular physical activity — at least 30 minutes several times a week — can bring blood pressure down to safer levels, or help to avoid developing hypertension altogether if the numbers are only slightly high (elevated hypertension).
CLOSE
Types of exercise that are well-suited to lowering blood pressure include walking and hiking, jogging, cycling, swimming and dancing. Weight training can also be beneficial.
Anyone with a long-term medical condition should speak to their doctor before starting a new exercise program, to check if they should be aware of any additional considerations.
Whatever the individual exercise routine looks like, it is important to be consistent and stick to it in order to keep blood pressure down.
High blood pressure
and sex
Although sexual activity is unlikely to pose an actual health risk for people with hypertension, high blood pressure can affect the quality of their sex life.
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Over time, high blood pressure damages the lining of blood vessels and causes them to stiffen and narrow, which limits blood flow.
For some men, this decreased blood flow makes it difficult to achieve and maintain erections, medically known as erectile dysfunction. The drugs used to treat hypertension can have similar effects, depending on their mechanism of action.
High blood pressure can also reduce sexual desire and increase anxiety and fatigue in both men and women, which can take a toll on relationships and emotional wellbeing.
By discussing any concerns with a doctor and seeking additional professional help if necessary, people with high blood pressure can address many of these problems. This might include switching to medications that may have fewer side effects.
Eating healthily
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The so-called DASH (Dietary Approaches to Stop Hypertension) eating plan is supported by the US National Institutes of Health and has been shown to be beneficial for people with and without hypertension. The eating plan is rich in whole grains, fruits, vegetables and low-fat dairy products, and is low in saturated fat, cholesterol, salt and added sugar. It includes the following elements:
Changing established eating habits is not easy, but some simple tricks can help:
Reducing salt (sodium) intake can make a positive difference on blood pressure. The DASH eating plan recommends a maximum of 2300 milligrams of sodium a day. In addition to reducing the intake of “regular” table salt, it is important to check the labels – and sodium levels – of prepared and processed foods.
Sodium occurs in a number of substances added to processed foods, such as glutamate and baking soda. Generally, unprocessed and whole foods are better choices for people on a low-salt diet. Fruits and vegetables in particular are important components of the DASH eating plan – they are low in sodium but high in potassium and can therefore improve the potassium-to-sodium ratio, which helps to lower blood pressure.
Go easy
on the salt
The beneficial effect of small amounts of alcohol is debatable when it comes to lowering blood pressure – and drinking more than that might not only raise blood pressure, but also make blood pressure medications less effective.
It is therefore recommended to keep to a limit of no more than one drink a day for women, or two drinks a day for men. One drink equals roughly 14 grams of pure alcohol – which is contained in a regular beer or small glass of wine, for example.
Limit alcohol intake
The nicotine in cigarettes raises blood pressure and heart rate immediately during smoking. In the longer term, tobacco can damage the lining of blood vessels, causing them to narrow and harden, which increases blood pressure and puts additional strain on the heart.
Don’t smoke
Stress is an important contributor to high blood pressure. While it is almost impossible to eliminate all of life’s stressors (be they related to work, family, money or health), there are a range of techniques to help manage them effectively:
Take a break from the stressor. It is not easy to give yourself permission to step away from that big work task (or from that annoying person at the Christmas party, for that matter). But allowing yourself to take
a breather can provide a fresh perspective and make you feel less overwhelmed.
De-stress
your life
Go easy on the salt
Limit alcohol intake
Don’t smoke
De-stress your life
Exercise. A quick walk or run can have an immediate positive effect that can last for several hours, even and especially on a stressful day.
Smile and laugh. Humor or just a friendly face can help to relieve tension and lower stress levels.
Be mindful. Meditation, yoga and other relaxation techniques have been shown to help some people to relax and focus, physically and mentally. Mindfulness can help to develop new perspectives and release emotions that may have contributed to the feeling of stress.
Talk about your feelings. Call a friend, meet for a walk with the neighbor or have lunch with a family member. Sharing your worries with a person you trust often alleviates stress. However, it’s important that the person you talk to is not one of your stressors.
Disclaimer
This resource has been developed by Idorsia Pharmaceuticals in order to provide an environment to deliver a better understanding of resistant hypertension and to pool information regarding the disease, the diagnosis procedure, available treatments and the impact it could have on the life of someone diagnosed with resistant hypertension. The resource is for use by a general audience.
The information in this resource is not intended as a substitute for advice/treatment by a physician, whose instructions should always be followed. Neither does the information provided constitute an alternative to advice from a doctor or a pharmacist and should not be used on its own to produce a diagnosis or to commence or cease a particular treatment.
The links provided are for informational purposes only; they do not constitute an endorsement or an approval from Idorsia Pharmaceuticals Ltd of the services or opinions of the corporation, organization or individual. Idorsia Pharmaceuticals Ltd bears no responsibility for the accuracy, legality or content of the external sites or subsequent links. You are requested to contact the respective external site for answers to questions regarding its content.
The information provided is valid on the publication date but may be subject to further modifications. Even though Idorsia aims to provide accurate and up to date information at all times, please acknowledge that the present resource is made available “as is”. Idorsia does not give any warranty or representation, whether expressly stated or implied, of any kind related to the comprehensiveness, usefulness, reliability or timelines of the content of this resource. Idorsia cannot be held liable for any direct or indirect damage of a material or non-material nature that might be caused by the use or non-use of the information presented.
Disclaimer
Go easy on salt
Limit alcohol intake
Don't smoke
De-stress your life
Reducing salt (sodium) intake can make a positive difference on blood pressure. The DASH eating plan recommends a maximum of 2300 milligrams of sodium a day. In addition to reducing the intake of “regular” table salt, it is important to check the labels – and sodium levels – of prepared and processed foods.
Sodium occurs in a number of substances added to processed foods, such as glutamate and baking soda. Generally, unprocessed and whole foods are better choices for people on a low-salt diet. Fruits and vegetables in particular are important components of the DASH eating plan – they are low in sodium but high in potassium and can therefore improve the potassium-to-sodium ratio, which helps to lower blood pressure.
Go easy on the salt
Limit alcohol intake
The beneficial effect of small amounts of alcohol is debatable when it comes to lowering blood pressure – and drinking more than that might not only raise blood pressure, but also make blood pressure medications less effective.
It is therefore recommended to keep to a limit of no more than one drink a day for women, or two drinks a day for men. One drink equals roughly 14 grams of pure alcohol – which is contained in a regular beer or small glass of wine, for example.
Don't smoke
The nicotine in cigarettes raises blood pressure and heart rate immediately during smoking. In the longer term, tobacco can damage the lining of blood vessels, causing them to narrow and harden, which increases blood pressure and puts additional strain on the heart.
Take a break from the stressor. It is not easy to give yourself permission to step away from that big work task (or from that annoying person at the Christmas party, for that matter).
But allowing yourself to take a breather can provide a fresh perspective and make you feel less overwhelmed.
Stress is an important contributor to high blood pressure. While it is almost impossible to eliminate all of life’s stressors (be they related to work, family, money or health), there are a range of techniques to help manage them effectively:
Exercise. A quick walk or run can have an immediate positive effect that can last for several hours, even and especially on a stressful day.
Smile and laugh. Humor or just a friendly face can help to relieve tension and lower stress levels.
Be mindful. Meditation, yoga and other relaxation techniques have been shown to help some people to relax and focus, physically and mentally. Mindfulness can help to develop new perspectives and release emotions that may have contributed to the feeling of stress.
Talk about your feelings. Call a friend, meet for a walk with the neighbor or have lunch with a family member. Sharing your worries with a person you trust often alleviates stress. However, it’s important that the person you talk to is not one of your stressors.
De-stress your life
Limit alcohol
intake
Go easy
on the salt
De-stress
your life
Don’t smoke
Go easy on the salt
Reducing salt (sodium) intake can make a positive difference on blood pressure. The DASH eating plan recommends a maximum of 2300 milligrams of sodium a day. In addition to reducing the intake of “regular” table salt, it is important to check the labels – and sodium levels – of prepared and processed foods.
Sodium occurs in a number of substances added to processed foods, such as glutamate and baking soda. Generally, unprocessed and whole foods are better choices for people on a low-salt diet. Fruits and vegetables in particular are important components of the DASH eating plan – they are low in sodium but high in potassium and can therefore improve the potassium-to-sodium ratio, which helps to lower blood pressure.
CLOSE
The beneficial effect of small amounts of alcohol is debatable when it comes to lowering blood pressure – and drinking more than that might not only raise blood pressure, but also make blood pressure medications less effective.
It is therefore recommended to keep to a limit of no more than one drink a day for women, or two drinks a day for men. One drink equals roughly 14 grams of pure alcohol – which is contained in a regular beer or small glass of wine, for example.
CLOSE
Limit alcohol intake
Don’t smoke
The nicotine in cigarettes raises blood pressure and heart rate immediately during smoking. In the longer term, tobacco can damage the lining of blood vessels, causing them to narrow and harden, which increases blood pressure and puts additional strain on the heart.
CLOSE
De-stress your life
Stress is an important contributor to high blood pressure. While it is almost impossible to eliminate all of life’s stressors (be they related to work, family, money or health), there are a range of techniques to help manage them effectively:
CLOSE
Take a break from the stressor. It is not easy to give yourself permission to step away from that big work task (or from that annoying person at the Christmas party, for that matter). But allowing yourself to take a breather can provide a fresh perspective and make you feel less overwhelmed.
Exercise. A quick walk or run can have an immediate positive effect that can last for several hours, even and especially on a stressful day.
Smile and laugh. Humor or just a friendly face can help to relieve tension and lower stress levels.
Be mindful. Meditation, yoga and other relaxation techniques have been shown to help some people to relax and focus, physically and mentally. Mindfulness can help to develop new perspectives and release emotions that may have contributed to the feeling of stress.
Talk about your feelings. Call a friend, meet for a walk with the neighbor or have lunch with a family member. Sharing your worries with a person you trust often alleviates stress. However, it’s important that the person you talk to is not one of your stressors.
Blood Pressure
Category
Systolic mm Hg (upper #)
Diastolic mm Hg (lower #)
Normal
less than 120
less
than 80
and
Elevated hypertension
120 – 129
or
less
than 80
High Blood Pressure (Hypertension) Stage 1
130 – 139
or
80 – 89
High Blood Pressure (Hypertension) Stage 2
140
or higher
or
90 or
higher
Hypertensive Crisis (Emergency
care needed)
higher
than 180
higher
than 120
or
less
than 120
Start motion
Stop motion
Stop motion
Start motion
Start motion
Stop motion